Successful treatment of chronic subdural haematoma after epidural anaesthesia for labour

Abstract

We report on a successful treatment for a very infrequent chronic subdural haematoma after epidural anaesthesia for labour. Our patient presented at the Emergency Department in her 35th day post-partum and, the urgent cranial scan showed a chronic subdural left hemispheric haematoma of 15.8 mm with displacement of middle line and herniation of 14 mm. Chronic subdural haematoma following epidural anaesthesia can occur after 3 to 7 weeks following epidural anaesthesia, and it should be considered even if no complications in the procedure were observed. If haematoma is under 5 mm, without other acute signs, conservative treatment is recommended. Programmed neurosurgery should be performed if haematoma is greater than 5 mm; but if rapid deterioration, urgent neurosurgery must be performed as soon as possible to avoid irreversible damage.

Keywords

Chronic subdural haematoma - Epidural anaesthesia - Subdural haematoma complications - Subdural haematoma in pregnancy - Surgical management

• References

• 1 Vaughan D.J., Stirrup C.A., Robinson P.N.. Cranial subdural haematoma associated with dural puncture in labour. Br J Anaesth 2000; 84: 518-520
• 2 García-Sánchez M.J., Prieto-Cuéllar M., Sánchez-Carrión J.M., Galdo-Abadín J.R., Martín-Linares J.M., Horcajadas-Almansa A.. Chronic subdural hematoma secondary to an accidental dural puncture during lumbar epidural anesthesia. Rev Esp Anestesiol Reanim 1996; 43: 327-329
• 3 Fujii M., Arai T., Matsuoka Y., Karakama J., Morimoto T., Ohno K.. Postpartum chronic subdural hematoma following spinal anesthesia: case report. No Shinkei Geka 2010; 38: 563-568
• 4 Kayacan N., Arici G., Karsli B., Erman M.. Acute subdural haematoma after accidental dural puncture during epidural anaesthesia. Int J Obstet Anesth 2004; 13: 47-49
• 5 Demetriades A.K., Sheikh M.F., Minhas P.S.. Fatal bilateral subdural haematoma after epidural anaesthesia for pregnancy. Arch Gynecol Obstet 2011; 284: 1597-1598